中国急性心肌梗死患者主动脉内球囊反搏应用现状及影响因素分析  

Status of intra-aortic balloon pump application and related factors in Chinese patients with acute myocardial infarction

作　　者：吴娜琼[1] 高展[1] 郑杨[2] 李卫 李军农 许海燕[1] 程晓曙[5] 吴元[1] 王杨 王志杰 杨进刚[1] 杨跃进[1] 无 

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外医院心内科,100037 [2]吉林大学白求恩第一医院心内科 [3]医学研究与生物统计中心 [4]陕西渭南市中心医院心内科 [5]南昌大学第二附属医院心内科 [6]代表中国急性心肌梗死注册登记研究组

出　　处：《中华心血管病杂志》2018年第1期26-31,共6页Chinese Journal of Cardiology

基　　金：中国医学科学院医学与健康科技创新工程（2016-12M-1-009）;“十二五”国家科技支撑计划（2011BAI11B02）;国家卫生和计划生育委员会公益性行业科研专项（2014020011

摘　　要：目的 了解中国急性心肌梗死患者应用主动脉内球囊反搏（IABP）的现状和心原性休克患者应用IABP的影响因素.方法 纳入中国急性心肌梗死（CAMI）注册研究（多中心前瞻性注册研究）中2013年1月1日至2014年9月30日在国内107家医院连续入选的急性心肌梗死患者26 592例,去除重要资料缺失患者30例后,最终分析急性心肌梗死患者26 562例.分析IABP的临床应用情况,并采用多因素logistic回归分析影响合并心原性休克AMI患者接受IABP治疗的因素.结果 共785例（3.0％）急性心肌梗死患者应用IABP,其中急诊经皮冠状动脉介入治疗（PCI）术前预防性应用占49.9％（381/763）,合并机械并发症占0.8％（6/785）.在984例急性心肌梗死合并心原性休克患者中,接受IABP治疗患者占12.0％（118例）.多因素logistic回归分析显示,影响心原性休克患者接受IABP治疗的因素包括血脂异常（OR=2.858,95％CI 1.397～ 5.846,P=0.004）、左心室射血分数（OR=0.977,95％CI 0.961～ 0.994,P=0.009）、应用多巴胺（OR=2.517,95％CI 1.500～ 4.224,P=0.001）、冠状动脉左主干病变（OR=2.817,95％CI 1.495～5.308,P=0.001）、GRACE评分（OR=1.006,95％CI 1.000～1.011,P=0.034）、接受急诊PCI（OR=4.508,95％ CI 1.673～ 12.146,P=0.003）、三级医院（OR=2.562,95％ CI1.498～4.384,P=0.001）和患者受教育程度高（OR=2.183,95％CI 1.056～ 4.509,P=0.016）.结论 在中国急性心肌梗死患者中,近半数患者在急诊PCI前预防性应用IABP,仅少量心原性休克患者应用IABP.病情严重程度、医院级别和患者受教育程度对心原性休克患者应用IABP有影响.Objective To investigate the current status of application of intra-aortic balloon pump （IABP） and analyze the factors which might impact the application of IABP in patients with acute myocardial infarction complicated with cardiac shock in China.Methods In China Acute Myocardial Infarction （CAMI） Registry,a nationwide,multicenter（107 hospitals）,prospective study,26 592 patients with acute myocardial infarction were enrolled consecutively between January 1,2013 and September 30,2014.After excluding of 30 cases due to missing important data,26 562 cases were analyzed.The application status of IABP was analyzed and multivariate logistic regression analysis was performed to determine the factors related to IABP application.Results A total of 785（3.0%） patients with acute myocardial infarction received IABP implantation,and 381（49.9%） patients belonged to preventive application of IABP before primary percutaneous coronary intervention,and 6（0.8%） patients were complicated with mechanical complications.There were 118（15.0%） patients with cardiac shock received IABP implantation,which accounted for 12.0% （118/984） of all patients with cardiac shock.Multivariate logistic regression analysis showed that the clinical independent factors of the decision of IABP insertion included dyslipidemia （OR=2.858,95%CI 1.397-5.846,P=0.004）,left ventricular ejection fraction （OR=0.977,95%CI 0.961-0.994,P=0.009）,usage of dopamine （OR=2.817,95%CI 1.495-5.308,P=0.001）,left main disease （OR=2.817,95%CI 1.495-5.308,P=0.001）,GRACE score （OR=1.006,95%CI 1.000-1.011,P=0.034）,receiving primary percutaneous coronary intervention （OR=4.508,95% CI 1.673-12.146,P=0.003）,teritiary hospitals （OR=2.562,95%CI1.498-4.384,P=0.001）,and higher education of the patients （OR=2.183,95%CI 1.056-4.509,P=0.016）.Conclusions Among the Chinese acute myocardial infarction patients who received IABP implantation,nearly half application of IABP are preventive implantation before primary percutaneous coro

关 键 词：心肌梗死 休克 心原性 主动脉内球囊反搏 

分 类 号：R542.22[医药卫生—心血管疾病]